| 1. |
- Aagaard, Knut E., et al.
(författare)
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Factors associated with healing failure after early repair of acute, trauma-related rotator cuff tears
- 2023
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Ingår i: Journal of Shoulder and Elbow Surgery. - : MOSBY-ELSEVIER. - 1058-2746 .- 1532-6500. ; 32:10, s. 2074-2081
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Tidskriftsartikel (refereegranskat)abstract
- Background: Healing failure after rotator cuff repair is a challenging problem. Acute, trauma-related tears are considered a separate entity and are often treated surgically. The aim of this study was to identify factors associated with healing failure in previously asymptomatic patients with trauma-related rotator cuff tears treated with early arthroscopic repair. Methods: This study included 62 consecutively recruited patients (23% women; median age, 61 years; age range, 42-75 years) with acute symptoms in a previously asymptomatic shoulder and a magnetic resonance imaging–verified full-thickness rotator cuff tear after shoulder trauma. All patients were offered, and underwent, early arthroscopic repair, during which a biopsy specimen was harvested from the supraspinatus tendon and analyzed for signs of degeneration. Of the patients, 57 (92%) completed 1-year follow-up and underwent assessment of repair integrity on magnetic resonance images according to the Sugaya classification. Risk factors for healing failure were investigated using a causal-relation diagram where age, body mass index, tendon degeneration (Bonar score), diabetes mellitus, fatty infiltration (FI), sex, smoking, tear location regarding integrity of the rotator cable, and tear size (number of ruptured tendons and tendon retraction) were included and analyzed. Results: Healing failure at 1 year was identified in 37% of patients (n = 21). A high degree of FI of the supraspinatus muscle (P = .01), a tear location including disruption of rotator cable integrity (P = .01), and old age (P = .03) were associated with healing failure. Tendon degeneration as determined by histopathology was not associated with healing failure at 1-year follow-up (P = .63). Conclusion: Older age, increased FI of the supraspinatus muscle, and a tear including disruption of the rotator cable increased the risk of healing failure after early arthroscopic repair in patients with trauma-related full-thickness rotator cuff tears.
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| 2. |
- Aagaard, Knut E., et al.
(författare)
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No differences in histopathological degenerative changes found in acute, trauma-related rotator cuff tears compared with chronic, nontraumatic tears
- 2022
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Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy. - : Springer Science and Business Media LLC. - 0942-2056 .- 1433-7347. ; 30:7, s. 2521-2527
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Acute trauma-related rotator cuff tears are believed to have better healing potential than chronic tears due to less degenerative changes of the tendons. However, the histopathological condition of tendons from trauma-related tears is not well investigated. The purpose of this study was to explore specific histopathological features in tendons from acute trauma-related full-thickness rotator cuff tears and to compare them to findings in tendons from nontraumatic, chronic tears. Methods: In a prospective cohort study, 62 previously asymptomatic patients [14 women, median age 61 years (range 42–75)] with trauma-related full-thickness rotator cuff tears were consecutively included. Arthroscopic repair was performed within 30 (median, IQR 25–37) days after the injury. During surgery, tissue biopsies were harvested from the supraspinatus tendons in 53 (86%) of the patients. In addition, similar biopsies were harvested from 10 patients undergoing surgery for chronic tears without history of trauma. All tissue samples were examined by a well-experienced pathologist under light microscope. Tendon degeneration was determined using the Bonar score whereas immunostaining was used for proliferation (Ki67), inflammation (CD45), apoptosis (p53) and haemosiderin staining to study traces of bleeding. Results: The median (IQR) Bonar score for the acute trauma-related biopsies was 10.5 (7.5–14.5) compared to 11 (5–12.8) for the control group with no statistically significant difference between the groups. No statistically significant between-group difference was found for the inflammatory index whereas tendons from patients with trauma-related full-thickness rotator cuff tears had statistically significantly higher apoptosis [3.1 (0.5–8.9) vs. 0.1 (0–1.5), p = 0.003] and proliferation [4.0 (1.8–6.9) vs. 0.4 (0–2.0), p = 0.001) indices than those undergoing surgery for chronic tears. Positive haemosiderin staining was found in 34% of tissue samples from patients with trauma-related tears compared to 10% in the control group (n.s). Conclusion: This study suggests that there is no difference with regard to degenerative changes between supraspinatus tendons harvested from patients with acute, trauma-related rotator cuff tears and patients with nontraumatic, chronic tears. Level of evidence: II.
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| 3. |
- Aagaard, Knut E., et al.
(författare)
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Physical therapists as first-line diagnosticians for traumatic acute rotator cuff tears : a prospective study
- 2018
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Ingår i: European Journal of Trauma and Emergency Surgery. - : Springer Science and Business Media LLC. - 1863-9933 .- 1863-9941. ; 44:5, s. 735-745
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Tidskriftsartikel (refereegranskat)abstract
- Background: Early diagnosis of traumatic acute full-thickness rotator cuff tears (FTRCT) is important to offer early surgical repair. Late repairs following fatty infiltration of the rotator cuff muscles have less favorable results. We think that physical therapists are valuable diagnosticians in a screening process. The objective of this study was to evaluate the usefulness of physical therapists as first-line diagnosticians in detecting acute traumatic FTRCT. Methods: Between November 2010 and January 2014, 394 consecutive patients having an age between 18 and 75 years who sought medical care because of acute shoulder trauma with acute onset of pain, limited abduction and negative plain radiographs were included in the study. A clinical assessment was conducted by a physical therapist 1 week after the trauma. The patients were divided into three groups by the physical therapist according to the findings: FTRCT (Group I, n = 122); sprain (Group II, n = 62); or other specific diagnoses (Group III, n = 210). Group III patients were discharged and excluded from the study. Magnetic Resonance Imaging shoulder was performed for all Group I patients and for all patients with persistent symptoms in Group II. Results: 79/184 patients had FTRCTs documented by MRI in groups I and II. The clinical assessment of the physical therapist had a sensitivity of 85%, specificity of 68%, and usefulness index of 0.45 (> 0.35 considered useful) for diagnosing FTRCT. Conclusion: Physical therapists can be useful as first-line diagnosticians in detecting traumatic FTRCT.
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| 4. |
- Aagaard, Knut E., et al.
(författare)
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Return to work after early repair of acute traumatic rotator cuff tears
- 2020
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Ingår i: European Journal of Trauma and Emergency Surgery. - : Springer Science and Business Media LLC. - 1863-9933 .- 1863-9941. ; 46:4, s. 817-823
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Tidskriftsartikel (refereegranskat)abstract
- Background: Lost workdays following rotator cuff repair is not well-studied in the literature. We aimed to define the time away from work following early arthroscopic repair of acute traumatic rotator cuff tears and compare it with the recommendations of the American Medical Disability Advisor (MD Guidelines) and The Swedish Social Insurance Agency. Methods: Thirty-two consecutive working patients with a median age of 58 (42–70) years suffering from acute traumatic rotator cuff tears who underwent arthroscopic repair were prospectively studied. The studied variables were age, gender, alcohol use, smoking, number of injured tendons, dominant side involvement, work-related injury, employment status, preoperative work level, alterations of work tasks at return to work, and time away from work. Results: 97% of the patients returned to full-duty work. The median time to return to full-duty work was 5.0 (1.1–10.5) months. Preoperative work level (p = 0.025) and dominant side (p = 0.02) significantly affected the time away from work on the univariate analysis, while GLM model showed a trend (p = 0.09) for shorter sick leave by dominant side involvement. The sick leave was longer in all three work level categories compared with the MD Guidelines and longer in the light and medium work categories compared with the recommendations by FK. Conclusions: According to the present study, acute traumatic rotator cuff tears cause a considerable loss of work days. However, almost all patients are expected to return to work after a median time of 5 months following arthroscopic repair. Current guidelines and recommendations regarding sick leave following repair of rotator cuff tears might have to be reviewed.
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